Background: Transforaminal lumbar endoscopic discectomy is a minimally invasive spine
surgery procedure performed principally for the treatment of lumbar herniated discs. Endoscopic
spine surgeons around the world have noted how far patients will travel to undergo this minimally
invasive spine surgery, but the actual distance patients travel has never been investigated.
Objective: We present here our analysis of how far patients will travel for endoscopic spine
surgery by studying the referral patterns of patients to 3 centers in 3 different countries.
Study Design: Retrospective chart review of de-identified patient data was performed to
analyze the distance patients travel for spine surgery.
Methods: Patient demographic data was analyzed for patients undergoing transforaminal
lumbar endoscopic discectomy procedures over the same 8 month period in 2015 at centers in
the United States (U.S.), Netherlands, and Germany.
Results: Travel distances for patients were determined for 327 patients. The average distance
traveled for the U.S. center was 91 miles, the Dutch center was 287 miles, and the German
center was 103 miles. For the U.S. center 16% of patients traveled out of state for surgery and
for the European centers combined, 4% of patients traveled out of the country for surgery.
Limitations: The period of data analyzed was less than one year and the data collected was
analyzed retrospectively.
Conclusions: Quality metrics in health care tend to be focused on how health care is delivered.
Another health care metric that focuses more on what patients desire is presented here: how far
patients will travel for innovative spine care.
Key words: Endoscopic spine surgery, transforaminal, minimally invasive, travel, lumbar disc
herniation
A brief history of endoscopic spine surgery
